Sunken cheeks – HIV?

Dear Alice,

I am a 22 yr old gay guy who went on a date with a man off the internet. We didn't hit it off and I don't think I will see him again. One thing though, he had a very thin face with sunken cheeks even though he wasn't that old. My friend says it is a sign that he has AIDS. Is this true?

Dear Reader,

Isn't it handy how the internet can be a source of dates as well as information to explain some things about the people you date? The thinness and sunken cheeks of the person you went out with could have multiple explanations. It may be possible that the person you met had HIV. However, it can lead to inaccurate and hurtful assumptions to associate AIDS with a person just because they're gay or thin. It's possible the guy was just a thin person with prominent cheekbones.

Aside from body type or bone structure, one possible explanation of sunken cheeks is lipodystrophy (fat redistribution). Lipodystrophy can take two forms: lipoatrophy (fat wasting or fat loss) and hyperadiposity (fat accumulation). It often follows certain patterns, with fat being lost from the face, arms, legs, and buttocks, and accumulating on the stomach, breasts (in both men and women), and the back of the neck. Lipoatrophy is also sometimes associated with certain forms of diabetes, or it can be caused by genetics, abnormal immune system responses, or extreme exercise. Lipodystophy is also a side effect of certain HIV medications, or a symptom of prolonged, untreated HIV. That's probably the association your friend is making.

Eating disorders or insufficient calorie consumption can also result in extreme thinness. Another possible cause is gastroenteritis (more commonly referred to as "stomach flu"), which can cause vomiting and diarrhea. If left untreated, gastroenteritis can cause severe dehydration, a symptom of which is sunken cheeks or eyes. Hopefully your date did not have this while he was out with you!

So, all things said, there are many possible causes of sunken cheeks. While it may indeed have been associated with HIV infection, it could also be related to eating issues, untreated gastroenteritis, or other medical causes. However, it's best not to jump to conclusions… some people are just thin!

Last updated Jun 15, 2015
Originally published May 04, 2007

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